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1. Measure Details
Percentage of patients aged 65 years and older who have an advance care plan or surrogate decision maker documented in the medical record OR documentation in the medical record that an advance care plan was discussed but the patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. There is no diagnosis associated with this measure. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. Important Notes:- This measure can only be reported through a Registry or through claims. Elation recommends reporting through a registry for immediate feedback on performance.
- This measure is appropriate for use in all healthcare settings (e.g., inpatient, nursing home, ambulatory) except the emergency department. For each of these settings, there should be documentation in the medical record(s) that advance care planning was discussed or documented.
- Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.
2. Measure Parameters
Numerator: Patients who have an advance care plan or surrogate decision maker documented in the medical record OR documentation in the medical record that an advance care plan was discussed but patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan. You must use one of the following CPT Category II codes to document the numerator:- Advance Care Planning discussed and documented; advance care plan or surrogate decision maker documented in the medical record (1123F)
- Advance Care Planning discussed and documented in the medical record; patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan (1124F)
- Advance Care Planning not documented, reason not otherwise specified (1123F with modifier 8P)
- The CPT Category II codes used for this measure indicate Advance Care Planning was discussed and documented. The act of using the Category II codes on a claim indicates the provider confirmed that the Advance Care Plan was in the medical record (that is, at the point in time the code was assigned, the Advance Care Plan in the medical record was valid) or that advance care planning was discussed. The codes are required annually to ensure that the provider either confirms annually that the plan in the medical record is still appropriate or starts a new discussion.
- The provider does not need to review the Advance Care Plan annually with the patient to meet the numerator criteria; documentation of a previously developed advanced care plan that is still valid in the medical record meets numerator criteria.
- Services typically provided under CPT codes 99497 and 99498 satisfy the requirement of Advance Care Planning discussed and documented, minutes. If a patient received these types of services, submit CPT II 1123F or 1124F.
- 90791, 90832, 90834, 90837, 90845, 90846, 90847, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99218, 99219, 99220, 99221, 99222, 99223, 99231, 99232, 99233, 99234, 99235, 99236, 99291, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439
3. Elation Workflows
- During an encounter: In a visit note dated during the performance period, record that one of the following actions where taken with the patient using one of the CPT II Codes:
- Advance Care Planning discussed and documented; advance care plan or surrogate decision maker documented in the medical record (1123F)
- Advance Care Planning discussed and documented in the medical record; patient did not wish or was not able to name a surrogate decision maker or provide an advance care plan (1124F)
- Advance Care Planning not documented, reason not otherwise specified (1123F with modifier 8P).
- Using Document Tags: If an Advance Care Plan was discussed and documented, add one of the following Document Tags to a report or visit note based on the corresponding action taken:
- Care Plan w/ Surrogate Documented (1123F)
- Care Plan w/o Surrogate Documented (1124F)